| ?Objective?To explore the value of serum anti-Müllerian hormone in predicting the effect of ovulation induction with clomiphene citrate in infertile patients with polycystic ovary syndrome.?Methods?1.A total of 132 infertile patients aged 25-35 years old who met the diagnostic criteria of Rotterdam in 2003 were collected from the gynecological endocrinology clinic of Guangzhou first people's Hospital from July 2017 to December 2019.2.The patient's medical history,menstrual history,marriage and childbearing history,years of infertility and other medical history were collected,the height and weight of the patients were measured,and the body mass index((BMI))was calculated.On the second to third morning of drug withdrawal bleeding or spontaneous menstruation,fasting venous blood 2ml was taken to examine five items of sex hormones(luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E2),prolactin(PRL)),thyroid function(including thyroid stimulating hormone(TSH),total triiodothyronine(T3),total thyroid hormone(T4))and serum AMH,.The LH/FSH ratio was calculated.3.Transvaginal color Doppler ultrasound was performed on the 3rd to 5th day of drug withdrawal bleeding or spontaneous menstruation to determine the presence or absence of imaging polycystic ovarian changes(PCO).4.4.First of all,the patients were treated with Diane-35 for 3 cycles to adjust their menstruation.The regimen was as follows: one tablet a day was taken on the fifth day of the menstrual cycle,and discontinued after 21 days.If the patient had no menstruation for a long time,Diane-35 could be used on the fifth day after oral administration of dextroprogesterone 10 mg bid * 7 for 10 days with withdrawal bleeding.The second cycle of Diane-35 was taken in the same way on the 7th day after withdrawal,and the drug was used continuously for 3 courses.After 3 courses of treatment,clomiphene citrate was used to induce ovulation on the fifth day of the menstrual cycle.Clomiphene was given on the fifth day of menstrual cycle,once a day,50 mg once a day for 5 days.The development of follicles and endometrium were monitored by transvaginal ultrasound every other day or every day from the10 th day of the menstrual cycle,and the size,number and thickness of follicles were recorded.When the average diameter of dominant follicles was(MFD)? 18 mm,the patients were injected with human chorionic gonadotropin(h CG)6000-10000 IU intramuscularly to guide the patients to sleep with each other within 48 hours and be included in the reaction group to follow up the treatment results.If the number of follicles with MFD ? 12 mm revealed by B ultrasound is more than 3,in order to avoid the risk of ovarian hyperstimulation syndrome((OHSS))and multiple pregnancy,cancel h CG injection,advise patients to avoid strenuous activity,closely follow up,and also be included in the response group.If the patient does not see the dominant follicle(follicle diameter ?10mm)by the 35 th day of the menstrual cycle,the treatment and monitoring of ovulation induction will be terminated,considering that the patient is ineffective to the treatment of ovulation induction in this cycle,and will be included in the non-response group.Statistical processing: the measurement data are expressed by ±s for the data in accordance with the normal distribution,thetwo independent sample t-test is used to compare the data in accordance with the normal distribution,and the rank sum test is used to compare the differences between the data of non-normal distribution.Spearman or pearson correlation analysis was used to analyze AMH and its intergroup factors,logistic regression analysis was used to evaluate its effect on the outcome of ovulation induction,and ROC curve was used to evaluate the efficacy of serum AMH and other factors on ovarian response after ovulation induction with CC.?Results?1.There was no significant difference in age,BMI and years of infertility between the two groups(P >0.05).2.There were significant differences in serum AMH level,serum E2 level and endometrial thickness between the two groups(P <0.05),but there was no significant difference in serum basic FSH level,serum basic LH level,LH/FSH ratio,T and serum PRL water between the two groups.(P> 0.05).3.There was a positive correlation between serum AMH and serum T in patients with PCOS(P <0.05),but there was no significant correlation between serum AMH level and age,BMI,FSH,LH,LH/FSH,serum E2,PRL and endometrial thickness.(P>0.05).4.Logistic regression analysis was used to analyze the predictive indexes of AMH,E2,endometrial thickness and ovarian response of patients with PCOS after induction of ovulation with clomiphene.The corresponding regression coefficients were-0.437,-1.178 and-0.014,respectively(P<0.05).5.In the prediction of ovarian response of PCOS patients after induction of ovulation with clomiphene citrate,the corresponding AUC of serum AMH was 0.871(p<0.05),the best cut-off value was 7.865 ng / ml,the sensitivity was 80.0%,the specificity was 76.5%,and it had predictive value;the AUC of age and E2 were 0.598 and 0.596 respectively,which was not statistically significant(P>0.05).6.Through logistic regression analysis,it was concluded that endometrial thickness could predict the outcome of ovulation induction with clomiphene citrate in PCOS patients,and the regression coefficient was 0.756 respectively(P<0.05).7.The ROC curve was used to predict the treatment outcome of PCOS patients after induction of ovulation with clomiphene.The AUC corresponding to endometrial thickness was 0.661(p >0.05),which was not statistically significant.?Conclusion?1.AMH can be used as a predictive index to predict the ovarian response of patients with PCOS infertility after receiving CC ovulation induction therapy.When AMH ?7.865 ng / ml,it is recommended that patients do not use CC 50 mg ovulation induction regimen for 5 days,but can increase the dose of CC or switch to other ovulation induction regimens.2.Neither AMH nor endometrial thickness can be used to predict the outcome of PCOS infertile patients who received CC regimen for ovulation induction. |
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